Prescription Drug Costs on the Public’s Mind – Reductions in the Uninsured Not So Much

By Clive Riddle, September 30, 2016

The just released current Kaiser Family Foundation Tracking Poll finds that while the public continues to be deeply divided on the Affordable Care Act, they are fairly united in backing policy changes to rein in prescription drug costs. The level of bipartisan public support – powered by recent EpiPen pricing headlines among other Rx cost woes in the news -  would seem to offer a prescription paving the way for a rare event these days– legislation that has a chance of being enacted into law when the new Congress convenes next session.

There is widespread agreement on five policy points:

  1. 86% support requiring drug companies to release information to the public on how they set drug prices
  2. 82% favor allowing the federal government to negotiate with drug companies to get a lower price on medications for people on Medicare
  3. 78% approve of limiting the amount drug companies can charge for high-cost drugs for illnesses like hepatitis or cancer
  4. 71% like allowing Americans to buy prescription drugs imported from Canada
  5. 66% want an independent group that oversees the pricing of prescription drugs

Here’s a graphic Kaiser Family Foundation provided regarding the poll results:

The survey finds that “a large majority (77%) perceive drug costs as unreasonable, while one in five (21%) say they are reasonable. The share who say drug costs are unreasonable is up somewhat from 72 percent a year ago in August 2015.”  The Survey also finds that “about half (55%) of the public report currently taking prescription drugs, and the vast majority (73%) of them say paying for their medications is easy; far fewer (26% of those taking prescription drugs, or 14% of the total population) say it is difficult to pay for their drugs.”

The September tracking poll continues to reflect the deep partisan divide in views on the ACA, which spill over to recognition of a significant drop in the level of the uninsured:

  • 47 percent have an unfavorable view of the ACA while 44 percent have a favorable one. 
  • 48% say the marketplace in their own state is working well, while 43 percent say it is not working well, but 49% say they are not working well nationally vs. 44% that say they are working well.
  • “When asked whether the uninsured rate is at an all-time low or all-time high, a quarter (26%) are aware that it is at an all-time low, while a fifth (21%) say that it is at an all-time high. Democrats and those with a favorable view of the health reform law are more likely to be aware of this; Republicans and those with an unfavorable view are less likely to be aware.”


With regard to the current level of the uninsured, HHS this week released a report indicating “the uninsured rate fell by around 40 percent for Americans in all income groups for 2010 through 2015, including individuals with incomes above 400 percent of the federal poverty level (FPL).”
Here’s the levels of reduction in the rate of uninsured they found during this time period by income levels and age:

  • Less than 100% FPL: 39% reduction
  • 100-125% FPL: 48% reduction
  • 125-250% FPL: 41% reduction
  • 250-400% FPL: 37% reduction
  • 400% FPL and higher: 42% reduction
  • 18-25 year olds: 52% reduction
  • 26-34 year olds: 36% reduction
  • 35-54 year olds: 39% reduction
  • 55-64 year olds: 40% reduction

What Health Plans Should Know About Marketing Costs

By Claire Thayer, September 29, 2016

Getting your message in front of the right audience sounds easy enough, but can be quite complicated for health plans during open enrollment season as well as throughout the year for member outreach.  A recent study of administrative expenses for Blue Cross Blue Shield finds that the 26.5% of total PMPM expenses is attributed directly to sales and marketing activities.  Being judicious and figuring out best practices for member engagement, when to contact members, identifying the healthcare CEO of the household, what language members speak at home, etc. requires marketing tools with intelligence capabilities to optimize campaign initiatives.

Helping health plans to keep their marketing costs down is the focus of a recent MCOL infographoid, co-sponsored by LexisNexis Health Care, highlighted below:

MCOL’s weekly infoGraphoid is a benefit for MCOL Basic members and released each Wednesday as part of the MCOL Daily Factoid e-newsletter distribution service – find out more here.


I Really Wish You Wouldn't Do That

By Kim Bellard, September 22, 2016

Digital rectal exams (DREs) typify much of what's wrong with our health care system.  Men dread going to go get them, and -- oh, by the way – they apparently don't actually provide much value. By the same token, routine pelvic exams for healthy women also don't have any proven value either.

The recent conclusions about DREs come from a new study.  One of the researchers, Dr. Ryan Terlecki, declared: "The evidence suggests that in most cases, it is time to abandon the digital rectal exam (DRE).  Our findings will likely be welcomed by patients and doctors alike."

The study actually questioned doing DREs when PSA tests were available, but it's not as if PSA tests themselves have unquestioned value.  Even the American Urological Association came out a few years ago against routine PSA tests, citing the number of false positives and resulting unnecessary treatments.

Indeed, the value of even treating the cancer that DREs and PSAs are trying to detect -- prostate cancer -- has come under new scrutiny.  A new study tracked prostate cancer patients for ten years, and found "no significant difference" in mortality between those getting surgery, radiation, or simple active monitoring.

The surgery and radiation, on the other hand, had some unwelcome side effects.  Forty-six percent of men who had their prostate removed were wearing adult diapers six months later, and impotence was reported in 88% of surgical patients and 78% of radiation patients.

As for the pelvic exam, about three-fourths of preventive visits to OB-GYNs include them, over 60 million visits annually.  They're not very good at either identifying or ruling out ovarian cancer, and the asymptomatic conditions they can detect don't have much data to indicate that treating them early offers any advantage to simply waiting for symptoms.

Or take mammograms.  Mammograms are uncomfortable, have significant false positive/over-diagnosis rates, and costs us something like $4b annually in unnecessary costs, yet remain the "gold standard."

Then there is everyone's favorite test -- colonoscopies.  Only about two-thirds of us are getting them as often as recommended, and over a quarter of us have never had one.  There are other alternatives, including a "virtual" colonoscopy and now even a pill version of it, but neither has done much to displace the traditional colonoscopy.  And all of those options still require what many regard as the worst part of the procedure, the prep cleansing.

The final example is what researchers recently called an "epidemic" of thyroid cancer, which they attributed to overdiagnosis. In fact, according to the researchers: "The majority of the overdiagnosed thyroid cancer cases undergo total thyroidectomy and frequently other harmful treatments, without proven benefits in terms of improved survival."  Not only that, once they've had the surgery, most patients will have to take thyroid hormones the rest of their lives.

All of these examples happen to relate to cancer, although there certainly are similar examples with other diseases/conditions (e.g., appendectomy versus antibiotics for uncomplicated appendicitis).

Two conclusions:

1.  If we're going to have unpleasant things done to us, they better be based on facts

2.  We should do everything we can to make unpleasant things, well, less unpleasant:

Let's get right on those.


This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting




Workplace family monthly health premiums rise to $1,512; deductibles up 12% in 2016

By Claire Thayer, September 15, 2016

In 2016, employer-sponsored health insurance covered half of the non-elderly population.  For the 18th year in a row,  the Kaiser Family Foundation & Health Research & Educational Trust (HRET) published findings from its annual survey of employers reflecting trends of employer sponsored health benefits on premiums, employee cost-sharing, wellness programs and employer opinions in the 2016 Employer Health Benefits Survey.  Here are a few highlights:

  • The average premium for single coverage in 2016 is $536 per month, or $6,435 per year.
  • The average premium for family coverage is $1,512 per month or $18,142 per year
  • The $18,142 average family premium in 2016 is 20% higher than the average family premium in 2011 and 58% higher than the average family premium in 2006
  • Among those with a general annual deductible for family coverage, the percentages of covered workers with an average aggregate general annual deductible are 61% for workers in HMOs, 64% for workers in PPOs, and 77% for workers in POS plans
  • The share of covered workers in plans with a general annual deductible has increased significantly over time: from 55% in 2006, to 74% in 2011, to 83% in 2016, as have the average deductible amounts for covered workers in plans with deductibles: from $584 in 2006, to $991 in 2011, to $1,478 in 2016
  • Eighty-three percent of firms offering health benefits in 2016 offer only one type of health plan. Large firms are more likely to offer more than one plan type than small firms (53% vs. 16%)
  • Enrollment remains highest in PPO plans, covering just under half of covered workers, followed by HDHP/SOs, HMO plans, POS plans, and conventional plans.
  • Forty-eight percent of covered workers are enrolled in PPOs, followed by HDHP/SOs (29%), HMOs (15%), POS plans (9%), and conventional plans (< 1%)
  • Nearly all (more than 99%) covered workers work at a firm that provides prescription drug coverage in their largest health plan.
  • Sixty-one percent of covered workers are in a self-funded health plan.
  • Twenty-four percent of large firms (200 or more workers) that offer health benefits to their employees offer retiree coverage in 2016, similar to recent years.
  • Among large firms that have a health risk assessment, 54% offer an incentive to employees to complete the assessment

Says KFF President and CEO Drew Altman, “We’re seeing premiums rising at historically slow rates, which helps workers and employers alike, but it’s made possible in part by the more rapid rise in the deductibles workers must pay.”


More info:

  • Summary of findings is here
  • Entire report with over 200 exhibits in 14 different sections is here
  • News release is here
  • Health Affairs article is here



Uber, Lyft and Healthcare

By Clive Riddle, September 9, 2016

Bruce Japson, in his Forbes article earlier this summer - On-Demand Health's Growth Second Only To Uber And Lyft, that "investment in on-demand health services is projected to reach $1 billion in 2017 with Teladoc and rival telehealth firm American Well joining the likes of Uber and Lyft in the top 10 most funded on-demand companies, according to the most recent tally by consulting giant Accenture ACN -1.02%. Investment in on-demand health was just $200 million in 2014."

While Bruce was talking about valuations of on demand companies, it is most interesting that on a different level, the paths of healthcare and on demand ride services are converging.

Just this week, CareMore Health System touted their recent collaboration with Lyft that “Improves Access to Care, Reduces Transportation Cost and Wait Times” according to results from a pilot study of their Medicare Advantage beneficiaries that was just published in the Journal of the American Medical Association (JAMA),  in the article, “Nonemergency Medical Transportation: Delivering Care in the Era of Lyft and Uber

CareMore notes that “individuals using the service are now waiting an average of just nine minutes to be taken to or from their medical appointment” and that “average per-ride costs have been reduced by more than 30 percent (from $31.54 to $21.32). Satisfaction with the new program, which covers beneficiaries in selected areas of southern California, exceeded 80 percent.” CareMore plans to continue the program and potentially expand to markets beyond California.

Earlier this year, MedStar Health, the largest not-for-profit healthcare system in Maryland and the Washington, D.C., region, and Uber announced a collaboration “to give patients a new option for ensuring they can get to and from healthcare appointments. Patients who miss appointments or have to reschedule at the last minute frequently cite transportation as a factor.”

The Advisory Board, writing about in July, in their article “A surging trend: Uber, Lyft have hospitals rethinking patient access” reported that “other hospitals quickly became interested in MedStar's model, said Michael Ruiz, chief digital officer for MedStar. ‘We probably had 50 different systems across the country reach out to us and ask us 'How did you do it?’’ Several other hospitals have formed partnerships with Uber this year, including New Jersey-based Hackensack UMC and Florida-based Sarasota Memorial Hospital.”

How many years off are we from driverless Uber and Lyft cars picking us up for our healthcare visits?